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Medicina
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Abdominal Surgery: Innovative Techniques and Challenges
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Abdominal Surgery: Innovative Techniques and Challenges

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: 15 October 2026 | Viewed by 5594

Special Issue Editors

Dr. Tania Triantafyllou

E-Mail Website
Guest Editor
1st Propaedeutic Surgical Department, National and Kapodistrian University of Athens, Hippokrateion General Hospital, Athens, Greece
Interests: surgery; upper GI surgery; minimally invasive and laparoscopic surgery; robotic surgery; upper GI endoscopy; impedance pH-metry; esophageal cancer; hiatal hernia repair
Special Issues, Collections and Topics in MDPI journals
Dr. Athanasios Pantelis

E-Mail Website
Guest Editor Assistant
Surgical Department of Obesity & Metabolic Disorders, Psychiko Clinic, Athens Medical Group, Andersen Str., 1, Psychiko, 115 25 Athens, Greece
Interests: surgery; bariatric surgery; metabolic surgery; trauma; minimally invasive and laparoscopic surgery; surgical oncology

Special Issue Information

Dear Colleagues,

Abdominal surgery remains a cornerstone of general and specialized surgical care, encompassing a wide range of pathologies managed through elective and emergency procedures. In recent decades, the field has witnessed the steady integration of minimally invasive and robotic-assisted techniques, which have enhanced patient outcomes in terms of safety, recovery, and complication rates. Despite this progress, challenges remain in optimizing surgical decision-making, managing complex clinical cases, and standardizing care across diverse healthcare systems.

This Special Issue, entitled “Abdominal Surgery: Innovative Techniques and Challenges”, invites high-quality submissions focused on real-world improvements in surgical techniques, patient selection, perioperative management, and long-term outcomes. We welcome the submission of original research articles, clinical trials, and systematic reviews (+/− meta-analyses) that explore surgical strategies in benign and malignant disease, innovations in minimally invasive approaches, risk stratification, and postoperative complication prevention.

Particular emphasis will be placed on evidence-based practices that improve patient safety and outcomes, including enhanced recovery protocols, surgical education, and the multidisciplinary management of surgical disease. Submissions that evaluate the role of technology (e.g., intraoperative imaging or AI-supported clinical decision-making) are also welcome to be submitted, provided that they are firmly grounded in clinical utility and outcomes.

This Special Issue seeks to bring together the expertise of abdominal surgeons and multidisciplinary teams to advance the field through critical evaluation and the dissemination of clinically relevant innovations.

Dr. Tania Triantafyllou
Guest Editors

Dr. Athanasios Pantelis
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • minimally invasive surgery
  • abdominal surgery
  • surgical innovation
  • laparoscopy
  • robotic surgery
  • embedded systems
  • image-guided surgery

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Published Papers (6 papers)

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15 pages, 577 KB  
Article
Effects of a Lidocaine-Loaded Alginate/CMC/PEO Electrospun Nanofiber Film on Postoperative Pain and Peritoneal Adhesion in a Rat Model
by Ha-young Kim, Hyo-jin Kim, Geun Joo Choi and Hyun Kang
Medicina 2026, 62(4), 789; https://doi.org/10.3390/medicina62040789 - 20 Apr 2026
Viewed by 374
Abstract
Background and Objectives: Postoperative pain and intra-abdominal adhesions are common complications following surgery. Pain delays early mobilization, whereas adhesions can lead to bowel obstruction, chronic pain, or infertility. Current treatments, including systemic analgesics and physical barrier methods, are only partially effective. We [...] Read more.
Background and Objectives: Postoperative pain and intra-abdominal adhesions are common complications following surgery. Pain delays early mobilization, whereas adhesions can lead to bowel obstruction, chronic pain, or infertility. Current treatments, including systemic analgesics and physical barrier methods, are only partially effective. We hypothesized that combining these modalities would yield superior outcomes. Accordingly, we investigated whether a lidocaine-loaded alginate–carboxymethyl cellulose–polyethylene oxide (ACPE) electrospun film could more effectively reduce both postoperative pain and adhesion formation than either component alone. Materials and Methods: An electrospun nanofiber film composed of ACPE containing lidocaine was prepared. Its effects were evaluated in rats using an incisional pain and a peritoneal adhesion model. Four groups were compared: saline control, free lidocaine, drug-free ACPE film, and lidocaine-loaded ACPE film. Fifteen rats were allocated to each group. The primary outcome was the mechanical withdrawal threshold (MWT) after plantar incision, while secondary outcomes included histological changes and adhesion scores assessed by the Moreno system. Results: The lidocaine–ACPE film significantly increased MWT compared with all other groups, demonstrating a stronger and longer-lasting analgesic effect than free lidocaine. Adhesion scores were also lowest in the film group. Histological analysis confirmed a reduction in inflammatory cell infiltration and collagen deposition. Conclusions: A lidocaine-loaded ACPE nanofiber film effectively reduced both postoperative pain and adhesion formation in a rodent model. The combination of sustained local drug release and physical barrier function provides a promising strategy to address two major postoperative complications. Further preclinical studies are warranted before clinical application. Full article
(This article belongs to the Special Issue Abdominal Surgery: Innovative Techniques and Challenges)
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12 pages, 688 KB  
Article
One-Stitch Versus Traditional Ileostomy After Low Anterior Resection for Rectal Cancer: A Retrospective Cohort Study
by Ahmet Sencer Ergin, Ali Karabulut, Alparslan Saylar, Nihat Buğdaycı and Hakan Yiğitbaş
Medicina 2026, 62(3), 423; https://doi.org/10.3390/medicina62030423 - 24 Feb 2026
Viewed by 642
Abstract
Background and Objectives: Diverting ileostomy is frequently used after low anterior resection (LAR) for rectal cancer to mitigate the clinical consequences of anastomotic leakage. The one-stitch method (OM) has been proposed as a simplified alternative to the traditional method (TM), with potential [...] Read more.
Background and Objectives: Diverting ileostomy is frequently used after low anterior resection (LAR) for rectal cancer to mitigate the clinical consequences of anastomotic leakage. The one-stitch method (OM) has been proposed as a simplified alternative to the traditional method (TM), with potential procedural advantages. However, evidence regarding its short-term outcomes and procedural efficiency remains limited and largely context-specific. This study aimed to compare perioperative outcomes of OM and TM in a single-center cohort. Materials and Methods: This retrospective cohort study included patients who underwent LAR with diverting ileostomy for rectal cancer, between January 2022 and November 2025. A total of 67 patients were analyzed (OM: n = 31; TM: n = 36). Operative time, intraoperative blood loss, length of hospital stay, stoma-related complications, overall postoperative morbidity and anastomotic leakage were compared. Subgroup analysis was performed for laparoscopic cases. Multivariable logistic regression was used to explore factors associated with postoperative complications. Results: Baseline demographic and clinical characteristics did not differ significantly between groups. The OM was associated with shorter operative time and lower intraoperative blood loss compared with TM, both in the overall cohort and in the laparoscopic-only subgroup. No statistically significant differences were observed between OM and TM regarding stoma-related complications, overall postoperative complications or anastomotic leakage. Length of hospital stay was shorter in the TM group. In multivariable analysis, ileostomy technique was not independently associated with postoperative complications, whereas laparoscopic surgery was associated with a lower likelihood of postoperative complications. Given the limited sample size, the study was underpowered for infrequent safety endpoints. Conclusions: In this single-center retrospective analysis, the OM was associated with improved procedural efficiency but did not demonstrate a clear advantage in postoperative recovery or hospital stay. No statistically significant differences in short-term morbidity were observed; however, equivalence cannot be inferred due to limited statistical power. These findings should be interpreted as regional validation data and underscore the need for larger prospective studies incorporating longer-term and patient-centered outcomes. Full article
(This article belongs to the Special Issue Abdominal Surgery: Innovative Techniques and Challenges)
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16 pages, 2375 KB  
Article
Laparoscopic Approach to Median Arcuate Ligament Syndrome: A Single-Center Experience
by Matas Pažusis, Ieva Ramanauskaitė, Laima Maleckienė, Elita Drobužaitė, Linas Velička, Almantas Maleckas and Mindaugas Kiudelis
Medicina 2026, 62(2), 356; https://doi.org/10.3390/medicina62020356 - 11 Feb 2026
Viewed by 601
Abstract
Background and Objectives: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, is a vascular compression disorder. Over time, laparoscopy has become increasingly important in the treatment of MALS, gradually replacing open surgical reconstruction as the preferred first-line approach in most [...] Read more.
Background and Objectives: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, is a vascular compression disorder. Over time, laparoscopy has become increasingly important in the treatment of MALS, gradually replacing open surgical reconstruction as the preferred first-line approach in most cases. We present nine years of experience managing patients with MALS, aiming to contribute to the evidence supporting this long-debated condition. Materials and Methods: A single-center prospective observational cohort study analysis was conducted. CT angiography was used to confirm the diagnosis of MALS in all patients. All surgical patients completed the Gastrointestinal Quality of Life Index (GIQLI) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires preoperatively and postoperatively. All the patients underwent laparoscopic decompression. Postoperative follow-up visits were scheduled at one month and three years postoperatively. Results: During the study period, 37 patients were diagnosed with MALS, of whom 11 (29.7%) were symptomatic and underwent laparoscopic decompression. The operated cohort consisted of nine women and two men (mean age 56.7 ± 10.7 years). All patients reported postprandial epigastric pain, and 63.6% experienced weight loss. Laparoscopic decompression was successfully completed in all cases without intraoperative complications. Two patients had stenting after surgery, and in two, prior to surgery. The mean operative time was 103 ± 54 min, and the mean hospital stay was 4.2 ± 2.2 days. At 3-year follow-up, 36.4% of patients reported recurrent symptoms associated with recurrent celiac trunk stenosis on CT angiography. Overall, the patients had less indigestion and less pain; however, the differences did not reach a statistically significant level. Conclusions: Laparoscopic decompression of the median arcuate ligament is a feasible and safe treatment for carefully selected patients with symptomatic MALS, offering durable symptom relief in most cases with minimal morbidity. Full article
(This article belongs to the Special Issue Abdominal Surgery: Innovative Techniques and Challenges)
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11 pages, 560 KB  
Article
Rendezvous Stenting Technique for Anastomotic Leak After Total Gastrectomy: A Feasibility Study
by Konstantinos Saliaris, Sofia Katsila, Tania Triantafyllou, Eleni Kitsou, Konstantinos Kakounis, Panagiotis Varsos, Alexandra Triantafyllou, Andreas Theodorou, Athanasios G. Pantelis, Vassiliki Xiromeritou and Dimitrios Theodorou
Medicina 2026, 62(2), 352; https://doi.org/10.3390/medicina62020352 - 10 Feb 2026
Viewed by 1045
Abstract
Background and Objectives: Anastomotic leak following total gastrectomy and Roux-en-Y reconstruction remains a challenging and potentially morbid clinical scenario. Systemic support and resuscitation with simultaneous local sepsis control remain pillars of treatment. The therapeutic strategy may vary among different centers depending on [...] Read more.
Background and Objectives: Anastomotic leak following total gastrectomy and Roux-en-Y reconstruction remains a challenging and potentially morbid clinical scenario. Systemic support and resuscitation with simultaneous local sepsis control remain pillars of treatment. The therapeutic strategy may vary among different centers depending on the severity of clinical presentation, the degree of contamination and the hospital resources. The aim of this study is to introduce the rendezvous stenting technique, which combines washout of the abdominal cavity and endoscopic stenting under direct vision in selected patients who require reoperation. Materials and Methods: A retrospective descriptive analysis of severely ill patients suffering an anastomotic leak from an esophagojejunal anastomosis, who had been operated on in our department during the last five years was performed. Patient demographics, perioperative data and surgical outcomes were collected. Results: Since 2018, six anastomotic leak patients underwent stenting of anastomotic leak using the rendezvous technique during reoperation. Stenting was effective in controlling local contamination in five out of six patients (83.3%). One patient required repeat stent placement due to improper stent width. Conclusions: Anastomotic stenting using the rendezvous technique is a safe and feasible technique. Combining drainage of the abdominal cavity and stent fixation allows for control of the contaminated field as well as minimizing the risk of stent migration. Full article
(This article belongs to the Special Issue Abdominal Surgery: Innovative Techniques and Challenges)
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16 pages, 947 KB  
Article
Alterations in Gut Microbiota After Upper Gastrointestinal Resections: Should We Implement Screening to Prevent Complications?
by Urška Novljan, Žan Bohinc, Niko Kaliterna, Uroš Godnov and Tadeja Pintar Kaliterna
Medicina 2025, 61(10), 1822; https://doi.org/10.3390/medicina61101822 - 11 Oct 2025
Cited by 2 | Viewed by 1520
Abstract
Background: Surgical procedures and alterations of the gastrointestinal (GI) tract increase the risk of small intestinal bacterial overgrowth (SIBO), which is associated with GI symptoms and complications that compromise postoperative recovery. However, the prevalence and clinical impact of SIBO after various upper [...] Read more.
Background: Surgical procedures and alterations of the gastrointestinal (GI) tract increase the risk of small intestinal bacterial overgrowth (SIBO), which is associated with GI symptoms and complications that compromise postoperative recovery. However, the prevalence and clinical impact of SIBO after various upper GI surgical procedures remain poorly understood. Objective: This study aimed to evaluate the prevalence of SIBO after different types of upper GI surgery and to investigate the associated clinical factors. Methods: We conducted an observational study involving 157 patients with a history of upper GI surgery: Roux-en-Y gastric bypass (RYGB), laparoscopic single-anastomosis gastric bypass (OAGB), subtotal (STG) or total gastrectomy (TG), subtotal (SP)or total pancreatectomy (TP), cephalic duodenopancreatectomy (WR), and small bowel resection for Crohn’s disease. A glucose–hydrogen breath test was performed, and demographic, clinical, and treatment-related data were collected. Statistical analyses included t-tests, non-parametric tests, ANOVA, and correlation analyses using R software. Results: At a median follow-up of 25.7 ± 18.1 months, 31% (48/157) of patients tested positive for SIBO. The highest prevalence was observed after RYGB and OAGB (43%), followed by TG (30%), STG (29%), TP/WR (28%), and Crohn’s disease bowel resection (19%). No cases of SIBO were observed after SP. SIBO positivity was significantly associated with bloating and flatulence (p = 0.002), lactose intolerance (p = 0.047), systemic sclerosis (p = 0.042), T2D (p = 0.002), and exposure to adjuvant chemotherapy (p = 0.001) and radiotherapy (p = 0.027). In addition, the risk of SIBO increased proportionally with the duration of GI resection or exclusion (p = 0.013). Conclusions: In our study, the prevalence of SIBO after upper GI surgery was 31%, with the highest incidence (43%) observed in metabolic surgery patients. Importantly, adjuvant radio/chemotherapy was associated with an increased risk of SIBO, and extensive small bowel resection or exclusion was strongly associated with an increased risk of SIBO. Furthermore, the limitations of current diagnostic methods, which lack sufficient sensitivity and specificity, highlight the importance of early screening and standardization of diagnostic techniques to improve patient management and outcomes. Full article
(This article belongs to the Special Issue Abdominal Surgery: Innovative Techniques and Challenges)
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18 pages, 826 KB  
Systematic Review
Effect of Local Anesthetics on Experimental Postoperative Adhesion: A Systematic Review and Meta-Analysis with Trial Sequential Analysis
by Joon-hee Lee, Donghyun Lee and Hyun Kang
Medicina 2025, 61(12), 2215; https://doi.org/10.3390/medicina61122215 - 15 Dec 2025
Viewed by 748
Abstract
Background and Objectives: We performed a systematic review and meta-analysis using trial sequential analysis (TSA) to investigate the potential preventive postoperative antiadhesive effects of local anesthetics (LA). Materials and Methods: A comprehensive search was conducted using Ovid-MEDLINE, Ovid-EMBASE, Web of Science, [...] Read more.
Background and Objectives: We performed a systematic review and meta-analysis using trial sequential analysis (TSA) to investigate the potential preventive postoperative antiadhesive effects of local anesthetics (LA). Materials and Methods: A comprehensive search was conducted using Ovid-MEDLINE, Ovid-EMBASE, Web of Science, and Google Scholar to identify animal studies that explored the postoperative antiadhesive effect of LA applied in the surgical area. The primary outcome was the macroscopic adhesion score, including adhesion quality, quantity, and total adhesion score, whereas the secondary outcome was the microscopic adhesion score, including adhesion severity, inflammation, and fibrosis. Certainty of evidence was assessed using a GRADE-adapted framework for animal studies. Results: The comprehensive analysis involved 227 rats across 6 animal studies, with 158 rats subjected to LA and the remaining 69 administered a placebo or received no treatment. For macroscopic adhesion score, LA were associated with reductions in the total adhesion score (standardized mean difference (SMD) −1.528; 95% confidence interval (CI) −2.081 to −0.976; I2 = 30.0%) and adhesion quality (SMD: −0.996; 95% CI −1.906 to −0.085; I2 = 72.6%), while no significant difference was observed in adhesion quantity (SMD −0.544; 95% CI −1.452 to 0.365; I2 = 77.6%). For the microscopic adhesion score, LA appeared to reduce adhesion severity (SMD −1.304; 95% CI −1.862 to −0.746; I2 = 31.7%) and fibrosis (SMD: −2.373; 95% CI −3.400 to −1.346; I2 = 60.4%), whereas the effect on inflammation was inconsistent. Across all macroscopic outcomes, TSA demonstrated that the accrued sample size was far below the required information size, and the certainty of evidence remained low to very low. Most included studies had unclear or high risks of bias, which reduces confidence in the synthesized estimates. Conclusions: LA may have a potential association with reduced postoperative adhesion formation; however, the certainty of evidence was low to very low, and TSA indicated insufficient required information size to draw firm conclusions. Full article
(This article belongs to the Special Issue Abdominal Surgery: Innovative Techniques and Challenges)
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